Das Ausmaß der Fibrose beim duktalen Pankreaskopfkarzinom korreliert mit der Prognose

by Julia Müller
Doctoral thesis
Date of Examination:2022-12-06
Date of issue:2022-11-29
Advisor:Prof. Dr. Jochen Gaedcke
Referee:Prof. Dr. Jochen Gaedcke
Referee:PD Dr. Alexander König
Persistent Address: http://dx.doi.org/10.53846/goediss-9544

 

 

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Abstract

English

Extension of fibrosis correlates with the prognosis for pancreatic ductal adenocarcinoma (PDA) Müller J, Kitz J, Bernhard M, Azizian A, Grade M, Ströbel P, Ghadimi M, Gaedcke J. Introduction For patients with PDA the desmoplastic/stromal reaction is present to a varial extent. Its role concerning the tumor’s aggression (level) is not clarified yet, whereas it is still unclear if there is a certain reference to the prognosis itself which can be made by the standardized histopathological assessment. Methods In this retrospective study there was consecutive material of 91 patients with PDA under investigation. For the normal, non-tumor tissue we analyzed the grade of fibrosis and the existence of an inflammatory response. The tumor tissue itself was distinguished for the grade of fibrosis, the existence of external mucus production, the presence of signet ring or osteoclastic giant cells and the extension of desmoplastic reaction and necrosis. The histopathological data has been correlated with the (primary) tumor size (T-level) and involved lymph nodes according TNM classification. Results Median fibrosis was detected in 5% (range: 0%-80%) of non-tumor material and in 60% (range 20%-90%) of tumor tissues. External mucus production was found in 23% (n=21), a desmoplastic/stromal reaction in 30% (n=28) and necrosis in 32% (n=29) of all cases. There is a significant negative correlation between the grade of fibrosis of the tumor samples compared to T-level (p=0,009) as well as a survival benefit for patients with >60% tumor-fibrosis. The existence of tumor necrosis (p=0,005) and also a desmoplastic/stromal reaction (p=0,03) correlate with a poorer overall survival. For the normal, non-tumor tissue no significant results could be evaluated. Conclusion There are some histopathological criteria like the tumor necrosis or the kind of desmoplastic morphology/character which correlate directly the PDA patients’ prognosis. A higher grade of fibrosis seems to go along with a survival benefit. For the future it is necessary to focus on these and further more criteria in standardized ways to detect and proof their significance as a prognostic marker for PDA. This should be done in prospective studies.
Keywords: pancreatic ductal adenocarcinoma
 
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